离体猪肝三维超声胆管造影的实验研究

目的 探讨三维超声胆管造影技术显示肝内胆管的可行性.方法 对5个离体猪肝不同肝叶的胆管分别进行插管,经插管注入1:20稀释的SonoVue超声造影剂后进行三维超声造影检查,分别评价可分辨最高胆管分支级别和图像质量,并与X线胆道造影作比较,评价其胆管树形态拟合度.结果 在5个离体猪肝中成功插管14个分叶,最高可显示至第3级分支,最高显示级别为第3、2、1级分支的比例依次为42.9%(6/14)、42.9%(6/14)、14.2%(2/14);图像质量优、中、差的比例依次为21.4%(3/14)、57.2%(8/14)、21.4%(3/14);与X线胆道造影比较,图像拟合度优、中、差的比例依次为42.9%(6/14)、42.9%(6/14)、14.2%(2/14).结论 三维超声胆管造影技术可能是一种显示胆管树解剖结构的全新影像学方法.     

离体猪肝三维超声胆管造影的实验研究

目的 探讨三维超声胆管造影技术显示肝内胆管的可行性.方法 对5个离体猪肝不同肝叶的胆管分别进行插管,经插管注入1:20稀释的SonoVue超声造影剂后进行三维超声造影检查,分别评价可分辨最高胆管分支级别和图像质量,并与X线胆道造影作比较,评价其胆管树形态拟合度.结果 在5个离体猪肝中成功插管14个分叶,最高可显示至第3级分支,最高显示级别为第3、2、1级分支的比例依次为42.9%(6/14)、42.9%(6/14)、14.2%(2/14);图像质量优、中、差的比例依次为21.4%(3/14)、57.2%(8/14)、21.4%(3/14);与X线胆道造影比较,图像拟合度优、中、差的比例依次为42.9%(6/14)、42.9%(6/14)、14.2%(2/14).结论 三维超声胆管造影技术可能是一种显示胆管树解剖结构的全新影像学方法.     

三维超声胆道造影显示肝内胆管的可行性和临床价值

目的探讨三维超声胆道造影技术显示肝内胆管的可行性和应用价值。方法对6例肝移植术切除的尸肝样本行三维超声胆道造影,经胆总管插管,注入1∶20稀释的超声造影剂SonoVue后,评价其图像质量、可显示的最高胆管分支级别和胆管显示度,并与X线胆道造影相比较,同时对照X线胆道造影评价其胆管树形态拟和度。结果三维超声胆道造影的图像质量稍劣于X线胆道造影,且有统计学差异。所有6例尸肝三维超声胆道造影均能显示立体胆管树状结构,最高可显示至(3.67±0.52)级肝内胆管,X线胆道造影则为(4.00±0.63)级,两者比较无显著性差异(P=0.465)。三维超声胆道造影第1、2级的胆道显示度评分与X线胆道造影比较均无统计学差异,而第3级胆道的显示度评分低于X线胆道造影,两者之间的差异有统计学意义(P0.05)。其两者的形态拟合度均可达优。结论三维超声胆道造影技术可能成为一种显示胆管树解剖结构的新方法。     

术中胆道超声造影评价肝移植供体胆管解剖结构:二维与三维超声显像的比较

目的比较二维和三维胆道超声造影技术评价活体肝移植胆道解剖结构的差异。方法对13例活体肝移植供体分别行二维及三维胆道超声造影检查,分别对图像质量、可分辨胆管分支的级别及不同级别分支的数目及胆管变异进行评估。两位医师盲法独立对二维及三维超声胆道造影图像进行评价,一致性分析用Kappa检验。结果二维与三维超声胆道造影的图像质量评分显示胆管级别和胆管分支总数目无统计学差异,但二维胆道造影在显示第5、6级末梢胆管分支数目上优于三维胆道造影。两位医师对不同级别胆管分支数目的一致性检验,三维图像评价之间的κ值为0.82;高于二维图像相应κ值0.51。13例中三维超声胆道造影显示3例存在胆道变异,而二维超声造影未能发现。结论三维胆道超声造影较二维超声造影评估胆道变异更准确,而二维胆道超声造影显示末梢小胆管优于三维胆道超声造影检查。     

经皮二维胆道超声造影的临床应用

目的 探讨经皮二维胆道超声造影(2D-CEUSC)评价胆道梗阻性疾病的临床价值。方法 对33例因胆道梗阻性病变接受T管(21例)或PTC管(12例)插管的患者进行2D-CEUSC检查,以X线胆道造影(CC)作为金标准,分别评估图像质量、显示肝内胆管的最高级别及对梗阻性病变(包括有无梗阻、梗阻水平、梗阻程度及梗阻原因)的判断。结果 全部33例2D-CEUSC均清晰显示肝内外胆管直至梗阻段,图像质量评分均为优或中,可满足诊断需要,但与CC的差异有统计学意义(P=0.005);在显示胆管级别方面,2D-CEUSC可清晰显示(3.64±0.96)级肝内胆管,而CC为(3.79±0.74)级,差异无统计学意义(P=0.268)。治疗后仍存在胆道梗阻的22例中,2D-CEUSC对14例的梗阻水平、梗阻程度及梗阻原因判断正确,其中2D-CEUSC对肝门部梗阻、狭窄大于50％、完全梗阻及肿瘤性梗阻的判断与CC符合率分别为85.71%(6/7)、100%(3/3)、100%(9/9)和100%(12/12),对小病灶引起的不完全性梗阻正确判断的例数较低。结论 作为一种新的胆道造影方法,2D-CEUSC对肝内胆管分支的显示情况与CC接近,可作为术前评估胆道梗阻的有益补充。     

超声造影检测移植肝肝门部胆管微循环的可行性研究

目的 探讨超声造影检测肝门部胆管微循环的可行性及其方法.方法 16例疑为移植肝胆道并发症者行肝门部胆管壁超声造影检查,按SonoVue用量不同(1.5 ml/次及2.4 ml/次)分为两组.比较两组的造影图像质量,图象质量分为优、一般、差三级.其中2例行二次肝移植者,以病肝标本为对照,了解术前常规超声及超声造影对肝门部胆管壁的显示是否准确.结果 16例胆管壁超声造影图像质量优良者8例(50%),一般者6例(37.5%),差者2例(12.5%).1.5 ml/次与2.4 ml/次剂量组间图像质量差异无统计学意义(P=0.78),两组图像质量优良及一般者均为7例(87.5%).2例肝门部胆管常规超声、超声造影图像与病肝标本对比表明,常规超声能准确显示肝门部胆管壁,超声造影则能检测出胆管壁内造影剂灌注状况.结论 肝门部胆管壁超声造影图象质量可满足诊断要求,能反映胆管壁微循环灌注.造影时每次注入1.5 ml SonoVue即可达到与2.4 ml相当的造影效果.     

活体肝移植供体术中胆管三维超声造影的初步应用

,两者显示能力相当(P=0.443);而且术中胆管三维超声造影对比X线胆管造影,其形态拟合度均可达优;其中术中胆管三维超声造影发现2例肝内胆管变异,均得到X线胆管造影及手术证实;术中胆管三维超声造影平均操作时间为(10.5±3.1)min;且所有进行术中胆管三维超声造影检查的供体和受体术中及术后随访中均未发生与造影剂相关的不良反应.结论 术中胆管三维超声造影是一种全新的胆管树显示方法,能够发现胆管变异,可以作为术中X线胆管造影有益补充.     

胆管超声造影的临床价值初探

目的 探讨胆管超声造影在评价梗阻性胆道疾病中的可行性.方法 20例梗阻性黄疸患者(结石4例,术后胆道狭窄2例,肿瘤性病变14例)行经皮经肝胆道引流术置管引流,并经引流管注射SonoVue和泛影葡胺行胆管造影.以手术或经皮经肝胆管造影(percutaneous transhepatic cholangiography,PTC)为金标准,分析各类病变的胆管超声造影(ultrasonic cholangiography,USC)表现和诊断的准确性.结果 ①20例均成功观察到超声造影剂在胆道内分布,19例显示了三级以上胆管.胆管内造影剂清晰显影持续时间可达6 min以上.未发生明确的并发症及造影后不适.②与手术及PTC对照,USC正确显示了其中18例的梗阻部位,USC对梗阻部位诊断的准确性为90.0%(18/20),对梗阻原因诊断的准确性为85.0%(17/20).结论 USC安全可行,能够清晰显示胆管树形态,对肝内胆管的显示率与PTC接近,作为一种新的胆管造影方法,在评估胆道梗阻性病变的部位和原因方面有一定价值,但需要进一步的研究证实.     

胆管内超声造影在经皮经肝胆道引流术中的应用价值

目的 探讨胆管内超声造影在超声引导下经皮经肝胆道引流术(PTCD)中的应用价值.方法 100例因梗阻性黄疸行超声引导下PTCD的患者中,64例患者经PTCD胆道引流管注入超声造影剂(SonoVue)行胆管内超声造影检查,观察引流管是否位于胆管腔内及引流管末端位置,并与常规超声比较.在胆管内超声造影指导下,判断肝门部梗阻患者需要留置的PTCD胆道引流管数目.所有患者均行X线胆道造影或CT胆道造影证实.结果 胆管内超声造影判断引流管是否在胆管腔内的准确率和引流管末端的显示率均为100%(64/64),均优于常规超声的89.1%(57/64)和54.7%(35/64),差异有统计学意义(P=0.013和χ2=37.495,P<0.001).35例肝门部梗阻患者中的17例患者根据胆管内超声造影的结果留置了2条以上的胆道引流管,以达到充分引流效果.结论 胆管内超声造影技术弥补了常规超声的不足,可以在PTCD术中常规应用.     

超声造影三维成像在移植肝肝动脉检查中的初步研究

目的探讨超声造影三维成像技术在移植肝肝动脉检查中的应用价值。方法对25例移植肝患者肝动脉进行二维及三维超声造影检查。评价三维图像中肝动脉显示的分支分级、图像质量水平;评价三维超声造影对移植肝动脉并发症的诊断价值。结果三维超声造影诊断移植肝血管通畅者20例,三维超声造影可显示肝动脉的树状结构,三维超声造影显示的肝动脉分级及图像质量均优于二维造影(P=0.0000)。三维超声造影正确鉴别诊断了3例移植肝动脉扭曲及2例肝动脉狭窄。结论三维超声造影可更清晰显示移植肝动脉结构,可提供比二维超声造影更丰富的诊断信息。     

Biliary elimination of cefotiam, an experimental and clinical study

Five isolated rabbit livers were in vitro perfused over a 3-hour period. After addition of 10 mg of cefotiam to the circulating blood, a biliary peak concentration of 76.2 +/- 14.2 micrograms/ml (mean +/- SEM) was reached between the 90th and 120th min; 3.1 +/- 0.4% of the dose given was excreted in the bile during the 3-hour period. In 10 recently cholecystectomized patients provided with a T-tube drain, 1 g of cefotiam was given intravenously. A biliary peak concentration of 340 +/- 81 micrograms/ml was observed 2 h later. 1.8 +/- 0.7% of the administered dose was recovered in the bile during the 12-hour period. In 5 clinically normal subjects given intravenously 1 g of cefotiam, 0.5 +/- 0.2% of the administered dose was found in the duodenal fluid aspirated over a 4-hour period. Cefotiam concentrations measured in choledochal and gallbladder bile collected simultaneously during operation 1 h after intravenous administration of 1 g of the drug to 10 patients were 502 +/- 102 micrograms/ml and 143 +/- 39 micrograms/ml, respectively; they exceeded significantly the concentration determined in the serum sampled at the same time (17.9 +/- 2.6 micrograms/ml). The biliary parameters of cefotiam were compared with those of 14 other beta-lactam antibiotics previously studied by the same procedure. The results of the present study are consistent with a possible beneficial effect of cefotiam in the treatment of biliary tract infections.     

磁共振胰胆管成像与弥散加权成像联合CT增强扫描对恶性胆道梗阻的诊断价值

  目的  分析探讨磁共振胰胆管成像(MRCP)与弥散加权成像(DWI)联合CT增强扫描对恶性胆道梗阻的定位定性诊断价值。  方法  选择2015年6月~2020年12月在我院收治的疑似恶性胆道梗阻患者80例,所有患者均接受MRCP、DWI、CT增强扫描检查与病理学诊断; 以病理学诊断为“金标准”,对比所有患者MRCP形态,比较MRCP+DWI单独检查与CT增强扫描检查对胆道梗阻定位、定性诊断价值。  结果  病理组织学结果显示,80例患者中良性肝外胆道梗阻患者33例(41.25%),其中胆管结石27例,胆管炎性狭窄6例; 恶性肝外胆道梗阻患者47例,占比58.75%,其中胆总管癌34例、壶腹癌4例、胰头癌9例; MRCP影像学特征显示,良性梗阻患者主要表现为“枯枝状”,恶性梗阻患者主要表现为“软藤状”; 两种检测方法中,MRCP+DWI联合CT增强扫描对胆道梗阻的定位诊断准确率高于MRCP+DWI诊断(P < 0.05);MRCP+DWI检查胆道梗阻对胆管结石、胆管炎性狭窄、胆管癌、胰头癌的诊断符合率均低于MRCP+DWI联合CT增强扫描,两种检查方法对壶腹癌的诊断符合率均为100%;MRCP+ DWI联合CT增强扫描定性诊断总符合率高于MRCP+DWI检查(P < 0.05)。  结论  MRCP+DWI联合CT增强扫描可对恶性胆道梗阻进行准确定位,还可提高定性诊断恶性胆道梗阻的准确率,值得临床推广使用。      

Point-of-Care Ultrasound–Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple

Background

Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO.

Rapid active transport of immunoglobulin A from blood to bile

Immunoglobulins were isolated from the serum or ascitic fluid of Lou/Wsl rats bearing plasmacytomas and labeled with 125I. When labeled IgA was injected i.v. it disappeared from the blood serum much more rapidly than IgG2 so that after 3 h less than 10% remained. This rapid disappearance of the injected IgA was not seen in rats with ligated bile ducts. In rats with cannulated bile ducts, the labeled IgA appeared rapidly in the bile so that 25% of the injected dose was recovered in 3 h; at the peak of this biliary excretion the specific radioactivity of the bile (cpm/milligram protein) was about 200 times greater than that of the blood serum. Thus much of the IgA which finds its way into the blood is rapidly and actively transported across the liver so that it enters the gut lumen via the biliary tract.     

Altered hepatobiliary disposition of acetaminophen glucuronide in isolated perfused livers from multidrug resistance-associated protein 2-deficient TR(-) rats

Previous studies have demonstrated that phenobarbital treatment impairs the biliary excretion of acetaminophen glucuronide (AG), although the transport system(s) responsible for AG excretion into bile has not been identified. Initial studies in rat canalicular liver plasma membrane vesicles indicated that AG uptake was stimulated modestly by ATP, but not by membrane potential, HCO(3)(-), or pH gradients. To examine the role of the ATP-dependent canalicular transporter multidrug resistance-associated protein 2 (Mrp2)/canalicular multispecific organic anion transporter (cMOAT) in the biliary excretion of AG, the hepatobiliary disposition of acetaminophen, AG, and acetaminophen sulfate (AS) was examined in isolated perfused livers from control and TR(-) (Mrp2-deficient) Wistar rats. Mean bile flow in TR(-) livers was approximately 0.3 microl/min/g of liver ( approximately 4-fold lower than control). AG biliary excretion was decreased (>300-fold) to negligible levels in TR(-) rat livers, indicating that AG is an Mrp2 substrate. Similarly, AS biliary excretion in TR(-) livers was decreased ( approximately 5-fold); however, concentrations were still measurable, suggesting that multiple mechanisms, including Mrp2-mediated active transport, may be involved in AS biliary excretion. AG and AS perfusate concentrations were significantly higher in livers from TR(-) compared with control rats. Pharmacokinetic modeling of the data revealed that the rate constant for basolateral egress of AG increased significantly from 0.028 to 0.206 min(-1), consistent with up-regulation of a basolateral organic anion transporter in Mrp2-deficient rat livers. In conclusion, these data indicate that AG biliary excretion is mediated by Mrp2, and clearly demonstrate that substrate disposition may be influenced by alterations in complementary transport systems in transport-deficient animals.     

Hepatobiliary tuberculosis: a review of presentations and outcomes

Hepatobiliary tuberculosis (HTB) is uncommon and can be difficult to diagnose. We present our experience with HTB (over a 10-year period). Fourteen patients were identified from a total of 1888 cases of tuberculosis (TB) infection during this period. Five patients had isolated organ involvement [hepatic (n=3) and biliary (n=2)], and 9 had multiorgan involvement [2 organs (n=7) and 3 organs (n=2)]. The overall annual incidence ranged from 0.0% to 1.05% of all TB infections. Common clinical presentations were weight loss (64%), loss of appetite (64%), abdominal pain (57.1%), fever (50%), jaundice (42.3%), and abdominal distension (14.3%). The median delay from symptom onset to presentation was 40.5 days (range, 7-730 days), and from first presentation to diagnosis was 15 days (range, 1-420 days). Malignancy was initially suspected in 86%. Chest radiographic changes consistent with pulmonary TB were seen in 29% (n=4). Two had active pulmonary TB. Adverse effects of treatment occurred in 42.9%, mainly drug-induced hepatitis and nonspecific gastrointestinal symptoms. Three patients with biliary involvement required long-term biliary stenting. The overall mortality was 14%. In conclusion, HTB is uncommon and is often associated with other organ involvement. Presentation is often delayed, which may lead to significant morbidity and mortality.